Benefits Verification Specialist

Summary

Join AssistRx, a top workplace, and help patients access needed medications and therapies. As a Benefits Verification Specialist, you will work with healthcare providers and insurance plans to gather patient insurance information and navigate complex reimbursement issues. You will support prior authorizations, appeals processes, and ensure cases move through the system efficiently. The role involves conducting benefit investigations, verifying patient benefits, identifying coverage restrictions, and documenting processes. You will also act as a liaison between field representatives, healthcare providers, and patients, reporting trends to management. AssistRx offers competitive compensation, flexible work options, and numerous benefits.

Requirements

• In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage
• 2 to 3 years of benefit investigation involving the analysis and interpretation of insurance coverage
• 2 to 3 years of experience interacting with healthcare providers in regard to health insurance plan requirements
• Excellent verbal communication skills and grammar

Responsibilities

• Work directly with healthcare providers & insurance plans/payers to gather information about a patient’s insurance and the coverage provided for a specific pharmaceutical product
• Support the healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues
• Provide support for Prior Authorizations (PA) for an assigned caseload and helps navigate the appeals process to access medications
• Ensure cases move through the process as required in compliance with company requirements and the organization's defined standards and procedures; in a manner that provides the best level of service and quality
• Conduct benefit investigations for patients by making outbound phone call to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers
• Verify patient specific benefits and document specifics including coverage, cost share and access/provider options
• Identify any coverage restrictions and details on how to expedite patient access
• Document and initiate prior authorization process and claims appeals
• Report any reimbursement trends or delays in coverage to management
• Act as a liaison for field representatives, health care providers and patients

Preferred Qualifications

Salesforce system experience

Benefits

• Preloaded PTO: 100 hours (12.5 days) PTO upon employment, increasing to 140 hours (17.5 days) upon anniversary
• Tenure vacation bonus: $1,000 upon 3-year anniversary and $2,500 upon 5-year anniversary
• Many associates earn the opportunity to work a hybrid schedule after 120 days after training
• Medical, dental, vision, life, & short-term disability insurance
• Teledoc services for those enrolled in medical insurance
• Competitive pay structure
• Matching 401(k) with immediate vesting
• Legal insurance